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General NPI Number Information
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NPI Number | 1710204326
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Entity Type | Organization
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Legal Business Name | ACKERMAN FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 136 NORTH LOUISVILLE STREET
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City | ACKERMAN
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State | MS
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Zip | 39735
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Country | US
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Telephone | 662-285-6702
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 524
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City | HERNANDO
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State | MS
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Zip | 38632-0524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. STANLEY MARSHAL WOODS
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Credential | DMD
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Telephone | 662-285-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 348508
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License Number State | MS
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